| Fulfillment Llc | |
|
14331 Crego St Caldwell ID 83607-4815 | |
| (208) 290-0075 | |
| Not Available |
| Full Name | Fulfillment Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 14331 Crego St, Caldwell, Idaho |
| Authorized Official Name and Position | Kendra Jean Nielson (COUNSELOR) |
| Authorized Official Contact | 2087570067 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fulfillment Llc 14331 Crego St Caldwell ID 83607-4815 Ph: (208) 284-7233 | Fulfillment Llc 14331 Crego St Caldwell ID 83607-4815 Ph: (208) 290-0075 |
| NPI Number | 1346954658 |
|---|---|
| Provider Enumeration Date | 01/11/2023 |
| Last Update Date | 01/11/2023 |
| Certification Date | 01/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346954658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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